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°�SJNNy /SC��9 <br />� F <br />P <br />hF CD9�. FL�O" 4E <br />iy Of S � N <br />STATE OF FLORIDA ) <br />COUNTY OF ) <br />ANTI - KICKBACK <br />City of Sunny Isles Beach <br />18070 Collins Avenue <br />Sunny Isles Beach, FL 33160 <br />Telephone: (305) 947 -0606 Fax: (305) 949 -3113 <br />ANTI - KICKBACK AFFIDAVIT <br />I, the undersigned, hereby duly sworn and deposed say that no portion of this sum herein Bid <br />will be paid to any employees of the City of Sunny Isles Beach or its elected officials as a <br />commission, kickback, reward or gift, directly or indirectly by me or any member of my firm or <br />by an officer of the corporation. <br />The foregoing instrument <br />20�, by <br />of persE44, as <br />executed]. <br />AFFIX NOTARY STAMP HERE: <br />By: )OP <br />Title: //P <br />was acknowledged before me this day of <br />p«y [name <br />[type of authority], for <br />[nammg-of —party on behalf of whom instrument was <br />91 A 11 ri <br />Print or Type Commissioned Name <br />Personally Known OR Produced Identification <br />Type of Identification Produced rL- �b C__ <br />DECEMBER 28, 2010 7 of 7 <br />RICHARD S MARTIN <br />Notary Public - State of Florida <br />My Comm. Expires Apr 2, 2014 <br />••i� F' Vii , i�P �. <br />Commission # DD 972545 <br />Bonded Through National Notary Assn. <br />91 A 11 ri <br />Print or Type Commissioned Name <br />Personally Known OR Produced Identification <br />Type of Identification Produced rL- �b C__ <br />DECEMBER 28, 2010 7 of 7 <br />